Farhan Asghar, Hong Zhu
According to global report on diabetes by world health organization 1.5 million deaths were directly caused by diabetes in 2012. Pancreas transplantation is the best known treatment for diabetes. Purpose of this review is to give an overview of pancreas transplantation and after a detailed introduction, develop a basic understanding of pancreas transplantation. An overview of the related literature will be assessed and a brief history of pancreas transplantation along with three types of pancreas transplantation (SPKT, PAK, PTA), will be presented. We will elucidate the lectors on how surgical procedure for procurement of pancreatic graft is carried out simultaneously with other organs, in three steps. In the recipient part we describe exocrine drainage of pancreatic graft systemic-bladder technique and systemic enteric technique (surgical procedure with different advantages and disadvantages briefly described in the article). While for endocrine drainage there will be presented two widely used techniques and systemic enteric and portal enteric. Immunosuppression for pancreas transplantation induction and maintenance therapy are recently the most used ones. Corticosteroids and steroid free management are under debate in recent years. In 50 years of transplant history there is no gold standard immunosuppression regimen. Although outcomes of pancreas transplantation improved in last decades, there is a decline in number of transplantation. This review is helpful to make a basic understanding of pancreas transplantation for new surgeons.
